Effectiveness of A Fall Prevention Checklist

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Running Head: EFFECTIVENESS OF A FALL PREVENTION CHECKLIST
NRS-441V: Capstone Project

Exemplar of Evidence-Based Practice
Running head: EFFECTIVENESS OF A FALL PREVENTION CHECKLIST
Effectiveness of a Fall Prevention Checklist Utilized During Nursing Rounds

Andrea Elena Medina
Grand Canyon University
NRS 441V: Professional Capstone
Instructors: Samantha Deck, Tonya Mcatee
December, 4 2016
Abstract
It may be difficult to pinpoint the exact reason why a patient falls, therefore this article
will review root causes of falls, preventative measures to decrease the amount of patient falls,
and an implementation that may significantly reduce the monthly amount of falls in a hospital.
Evaluation when a patient fell during the shift, nurse to patient ratios, and possible risk factors
are crucial elements to review and observe in order to decrease falls during a patients
hospitalization. Due to the increased rate of falls during inpatient hospitalization, a method must
be implemented to improve patient fall rate and prevent patients from acquiring hospital injuries.
There is a great benefit in incorporating a thorough program to decrease inpatient falls. After the
analyzation of several successful fall prevention programs, it is evident that an efficacious
program consisting of staff education and training; patient education, patient observation and
assessment, environmental modification, and staff compliance can lead to a tremendous
reduction in the overall prevalence of falls. A fall prevention program that incorporates these
crucial elements can be implemented at a low cost with a high return upon investment. This
article will summarize several research studies and provide knowledge from each body of
literature on the prevention of falls in inpatient settings. It will also highlight data analyzed and a
basis in developing a fall prevention program that includes fall-risk assessments, education, and
environmental management. With the increased rate of patient falls throughout hospitals across
the nation, implementing evidence-based interventions such as a fall preventions checklist during
nursing rounds, and enforcing compliance among staff will decrease patient fall rates and
improve nursing care.
Introduction and Background

Throughout the United States (US) 30-50% percent of patients who fall during their
hospital stay incur injuries (Schwendimann, Rene, Buhler, Hugo, De Geest, Sabina, Milisen,
Koen 2006). Some reasons that place patients at risk for falls are medical equipment, medication
given during or after a procedure, medical diagnosis, mental status changes, and age, which have
proven to increase the risk of falls in hospitals. Improving the process for fall prevention and
management is imperative to help decrease fall injuries that occur within the hospital setting.
Falling can lead to a variety of problems that greatly impact patients, nursing staff, and
the facility (Haines,Terry P. 2013). When a situation happens where a patient falls due to lack of
education or confusion, more money is spent trying to figure out how to prevent further falls,
educating nursing staff, and treating patients for more health issues (Bench, Suzanne D. 2014).
Not only does it cost more money, it costs so much time and frustration when this situation could
have been prevented if the nurse and patient were educated, and if proper fall prevention tasks
were followed appropriately. Nurses can often get overwhelmed with their work load and tasks at
hand they may get sidetracked and forget to use or set bed alarms or go around trying to use the
proper equipment that reduces falls. When small details are missed or forgotten, patient
outcomes are not always the safest.
The lack of being aware of the risk for falls during a patient stay has been observed
throughout their length of hospitalization. Education is a key factor to help increase awareness of
risk for falls with our patient population (Bench, Suzanne D. 2014). Patients can be educated on
the importance of placing call lights within reach and calling for assistance. Implementation of a

newly developed fall program needs to be put in place to help decrease the number of falls per
month.
A Fall Prevention Theory
The rate of falls in any inpatient unit demonstrates an elevation in pattern (Tzeng,HueyMing 2011). Evaluation when a patient fell during the shift, nurse to patient ratios, and possible
risk factors is crucial to review to help decrease falls during a patients stay. It may be difficult to
pinpoint the exact reason why a patient falls, but a fall scale or score assessment tool can help to
determine where the patients mobility level is at. Before the implementation of any fall scale, it
would be difficult to assess the mobility level of a patient, especially if they were confused or
uneducated in fall risks. In evaluating these factors of fall risk patients, a tool was invented to
help nurses assess a patients fall risk rate. If a patient had a fall score of 3 or more according to
the Schmid scale, they were at risk for falling and need interventions placed to prevent them
from falls (Schmid Score Assessment Tool, n.d.). While tools assesses a patients fall risks by an
evaluation tool that ranks the patients based on age, sex, it focuses on a patients mobility,
mentation, elimination, prior fall history, and current medication the patient is on (Schmid Score
Assessment Tool, n.d.).
This theory works to prevent falls in the proposed solution because it aims to prevent
falls by evaluation the stem of where a patients fall may occur from. This tool would also be
used to evaluate a patients fall risk upon admission, transfer, and shift change to keep the nurses
reminded of their patients possible fall risk. When they are scored above a three, there would be
interventions that nurses must act on. These simple fall prevention methods are the use of
nonskid yellow socks, fall prevention signs and hazard armbands to remind the nurse that the

patient is a fall risk, bed or chair alarms, and education to the equipment in the new environment.
Evidence has demonstrated that staff education and their consistence to the fall prevention
system are essential in lessening patient fall rate (Wilbert, 2013).
Methods and Objectives
Tzeng (2011) clarifies that the absence of information and caring state of mind from
registered nurses assume a part as the fundamental obstructions to implementing a fruitful
program that significantly decreased the fall rate. Tzeng expressed that a fall prevention
methodology, such as a fall risk assessment tool may incorporate a couple of educational
objectives. The first objective was to advance nurses' proficient learning and aptitudes in
developing part of this fall prevention program implementation. The second objective relies on
nurses to focus on using the idea to treat their patients as part of their family members. Patientfocused care hypothesis enables nurses to alter their view of providing compassionate care and
comprehension of their patients desires. The motivation of Tzengs objectives was the exchange
of obstructions and intercessions with hopes that the end goal would guarantee a successful fall
prevention program implementation in inpatient facilities.
The patient-focused care hypothesis will be utilized as the system for nurses when being
educated on fall prevention methods. There will be quarterly education classes on this tool and
ideas, questions, or concerns on how to improve the tool. The tool will be used upon admission,
transfer, discharge, and shift change. It will also be included in the chart so evaluation and
reevaluation of a patients mobility level can be evaluated. This will be a well-known tool that
even the patients will be educated on. Staff education and their consistence to adhere to the fall
prevention project are vital in decreasing patient fall rate (Wilbert, 2013). Allowing the

education received to settle in and truly understand the importance of a method that prevents
falls from occurring will not only keep patients safe, but it will increase nurses knowledge and
skill level in caring for patients. Expanded staff information about the fall prevention
mediations has ended up being huge in diminishing the rate of falls (Krauss, 2008). A nurse
must be aware of what their patients are capable of and incapable of by assessing and observing
their patient in the hospital environment. Incorporating critical thinking skills are crucial in
monitoring and caring for patients and this tool will assist in that area. It is the nurses'
obligation to survey and reassess patient's fall hazard utilizing their insight and apply the most
suitable fall prevention mediations (Graham, 2012). There are many activities and methods that
can be applied amid nursing adjusting on patients have brought about a critical reduction in fall
rate (Saleh, Nusair, Zubadi, and Shloul 2011). There are various units that use distinctive fall
prevention methods, empowering nurses to think critically and choose the most important fall
prevention measures according to the patient could build their consistence and confidence in
utilizing a fall prevention program (Tzeng &Yin 2014).
Method of Approval
For implementation of the fall prevention program to be considered, key stakeholders
will be identified by determining who will be affected by the study but possibly not directly
involved in the development or data collection for the study program (Ganz,D.A. 2009). These
stakeholders include, the inpatient population, the staffing pool that will be involved in the
collection of data, the interest in the outcome of the patients, physician participation in regards to
patients, and the staff involved being studied. The feedback from stakeholders early in the
proposal process which hopefully will lead to a Leadership buy-in, will then be a priority
(Ganz,D.A. 2009). It is important to clarify the commitment of stakeholder and be prepared for

the level of commitment to be varied among the stakeholders. When the commitment has been
identified and made, the program will then need to be integrated into the chosen medical-surgical
unit for a mock trial.
Fall Risk Implementation Tool
The decrease in fall rates with nursing mediation tasks such as the Schmid assessment
tool is crucial to nursing from many points of views. Fall prevention education is increasing and
progressing as it iterates, reiterates, and stresses the importance of proper patient care and
increasing nursing knowledge. Education with staff members also invites team building,
enhances patient fulfillment, and allows staff to be on the same page with patient safety. Amid
unit based staff meeting and educational classes, staff members are urged to give input
concerning the fall safety measure intercessions. This gives extraordinary chances to team
building. These classes are geared to improve staff information to benefit staff and patients
wellbeing. Eventually, the consistence rate in utilizing the fall prevention program will
considerably prevent patients from acquiring a hospital based fall and injury. Patients will
understand and welcome their nurses to help prevent them from falling to the floor and obtaining
another health issue. Both patients and nurses will feel more secure and comfortable in this
stressful environment. With the adjustment of an hourly adjusting implementation, a feature of a
fall prevention method will demonstrate a nurses nurturing quality and uplifting disposition to
their patients which builds patient fulfillment.
A Fall Deficit, Requiring a Change
Today in modern hospitals, medical-surgical units are filled with beds occupied by
patients who have been admitted for a variety of reasons. While all these patients may not share a

common diagnosis, they do share the common similarity of an increased fall rate (Tzeng,HueyMing 2011). Whether they are admitted for surgical procedures, injuries, dehydration, or
infections, these patients will have some sort of mobility issue throughout their hospitalization.
With the combination of an elderly population mixed with individuals of all adult ages who have
health issues, fall prevention has been a difficult task to manage, making the safety of patients a
challenge and the second leading cause of unintentional injury (Ireland, Sandra 2013). Although
rates of falls differ in comparison between hospitals of varying sizes, an average rate of 1000
falls per year can highlight the frequency of the issue (Schwendimann, Rene, Buhler, Hugo, De
Geest, Sabina, Milisen, Koen 2006). Additionally, these fall rates reflect only what have been
reported in; keeping in mind that under-reporting is also a factor.
Due to the high percentage of 15%50% of acquired injuries resulting from patient falls,
patients who already require hospitalization due to their illness may suffer severe consequences
from a fall (Schwendimann, Rene, Buhler, Hugo, De Geest, Sabina, Milisen, Koen 2006). These
consequences may include longer hospitalization, disability, rehabilitative care, and/or death
(Schwendimann, Rene, Buhler, Hugo, De Geest, Sabina, Milisen, Koen 2006). It is without a
doubt that patient falls may take a concerning toll on the patient and their family members, but
they also affect health care providers, nursing staff, the facility, treatment costs, complaints,
litigation, and as mentioned before, longer hospitalization (Haines,Terry P. 2013). Distress and
anxiety can still be brought to the patient and family members if the patient had a no harm fall
(Bench, Suzanne D. 2014). This would just be the beginning cycle of a patients negative
experience during their hospitalization, possibly making them more vulnerable and fearful than
before, which in return can make for a more stressful environment for everyone involved (Bench,
Suzanne D. 2014).

This negative cycle can also begin if the nurse taking care of a fall risk patient is
unknowledgeable or forgetful of the proper interventions to prevent a fall. Nurses can often get
overwhelmed with their work load and tasks at hand (Haines,Terry P. 2013). While distractions
occur frequently in this line of work, nurses often get sidetracked and forget to use or set bed
alarms and use the proper equipment that reduces falls. When small details are missed or
forgotten, patient outcomes are not always the safest. Education is power and when nursing staff
are involved in learning about evidence based practice to incorporate to their everyday skills,
patient satisfaction is most likely increased. The dual effort stems from a nursing effort to
prevent falls and educating the patient on proper fall prevention methods.
What Fall Rate is Acceptable in a Fall Prevention Program?
Balance is always a difficult task to manage when there are various opinions involved in
what is best for the patient. The challenge is trying to prevent falls from occurring by depending
on staff, compliance, patient privacy, and independence. When we monitor a patients every
move, especially during private moments of using the bathroom or getting bathed, patients can
feel violated and uncomfortable. If we are to prevent them from ambulating to the restroom alone
or unobserved, they may feel robbed of their independence and sequestration. We may reach our
goals of preventing them from falling but there are consequences to this. If we are constantly at
an arms length, we are robbing them of their independence and rehabilitation. A couple of days
of inactivity in relation to post-surgical procedures, bed rest, or during recovery may seem minor,
but this can significantly affect a patients balance and walking to a point where they are unable
to mobilize unattended.
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With this dilemma noted, preventing all patients from falling is near impossible and not a
reasonable goal due to the possible mobility consequences from occurring. There have been
times where nurses and patients have followed all procedures and policies correctly and there are
still instances where a fall cannot be prevented. Sometimes it is inevitable to completely prevent
a fall but there are several ways to severely decrease the amount of falls in patients that occur
monthly. The gravity of the issue stems from lack of patient education and ensuring that all
implementations to prevent falls are in place at the time of shift report. We can absolutely
decrease the amount and frequency of falls as well as risk factors that lead to them by several
interventions.
Proposed Implementation for Preventing Falls
Nationwide, hospitals vary from policies and procedures to guidelines for preventing
falls. Since an implementation program often requires many interventions, in which may require
financial need, it is useful to identify patients who have an increased risk of falling. Although
falls do not discriminate and anyone who is hospitalized is at risk for falling, the elderly
population of 65-85 years has a fall percentage of 80% that occur during hospitalization
(McMahon, Siobhan 2011). The causes of falls vary between patients and are difficult to
pinpoint. Whether a patient suffers from confusion, side effects from medications or anesthesia,
agitation, bathroom frequency, urgency, incontinence, decreased strength and balance issues, it is
always important to properly assess patients to identify risk factors with another nurse during
bedside report and shift change. This is where the implementation of a bedside report checklist
comes into play.
Solution
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There are various ways to prevent a patient from falling, but there are two main factors
that have proven to significantly decrease the amount of falls a patient may have during their
hospitalization. Patient education and a fall prevention program are two key factors in
significantly decreasing the monthly rate of falls. Patient education is an essential factor in
nursing practice. Education is used for all parts of the patients health management. When a
patient arrives to an inpatient unit, the patient must be educated on fall prevention as they are
getting familiarized to their new environment. Although the implementations of a fall prevention
program form might seem long and tedious, it is a great way to check that everything is done to
prevent a patient from falling during change of shift and throughout their hospitalization. This
form would basically be a checklist geared towards the need of each patient. While all forms
would be the same, only the check mark boxed checked designated for the patient would be
discussed during report. If the use of bedside report is practiced properly, nursing bedside report
can result in improved patient and nursing satisfaction and patient safety outcomes (SandJecklin, Kari 2014). During shift change, the nurses will be able to use their critical thinking
skills to reevaluate the patient to make sure that the correct boxes are marked for their fall risk
patient. These check boxes will include a patients mobility, mentation, elimination, prior fall
history, current medications, and equipment or methods needed for mobility and transfer. When a
patient arrives to a unit, this fall prevention program requires them to view a fall prevention
video along with being educated on the use of their call light, the importance of calling for
assistance when getting out of bed, and the equipment used and needed for proper mobilization.
There will be areas to check off all of these tasks on the form to inform the nurse if the task is
completed or not. If a patient is scored a fall risk, the checklist is required to be used during any
transportation and hand-off report. All fall risk patients are required to have a bed alarm on with
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their room door left open which will also be noted on the checklist. Ensuring that proper
equipment is available to the patient based on their needs and ability will need to be checked off
and charted once the task in completed. Included in the check list will be coded colored socks,
fall risk bracelets and a fall risk door sign.
Logistics of Implementation
Staff involvement is essential for the fall prevention program to be successful. With the
help of nursing educators, management, and a nurse team lead, a staff meeting will occur to
introduce the implementation by a presentation of the program. The presentation will include a
PowerPoint of what is expected and the goal of the implementation as well as a mock trial of a
checklist that can be used for any fall risk patient. The nurse educator and team lead will then
perform a scenario where they are doing bed side report with the use of the checklist. Along with
the fall prevention checklist, a few patient scenarios will be used with the checklist to practice
with. All questions, concerns, and adjustments will be taken into consideration before the
program is launched. A trial and error run of the program will next be initiated for at least six
months to allow for slow adaption and adjustments. After evaluating staff, surveying patients and
staff, and an assessment of the fall rate for three months after the implementation program, the
fall prevention plan will move throughout other units of the hospital where falls have previously
occurred. It is understood that change takes time and patience. Therefore, working this into
patient admission, transfer, shift change, and discharge will be a process that allows a slow
transition to work out all the downfalls. The culture of the unit will change because nurses will
be able to spend time with their patients during shift change and the patient will feel like they are
getting quality care.
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Resources Required
When there is a change in any work field, it has been a shared opinion that having a super
user, who is an expert and understands the change and goal of the implementation, makes for a
reliable resource when there are questions or concerns about the change. This super user will
most likely be the unit-based educator and nurse team lead. It may require increased finances to
have these staff members be present to help educate floor staff, but in the long run, patients will
be safer and the amount of financial burden and stress will be reduced by preventing patient falls.
If the proportion of cognitively intact patients falling on a ward under usual care conditions is
4% or greater, then provision of the complete program in addition to usual care will likely both
prevent falls and reduce costs for a health service (Haines, Terry P., Hill, 2013). These staff
members will make sure that staff is properly assessing a patients risk of falls by using the
preferred fall risk tool, assist with proper charting, and to help staff to properly use the checklist.
There will be checklists required for every patient during their hospitalization, so the
amount of papers and printing ink are endless. The benefit about having a checklist for patients is
that only one is needed for each individual patient and can be properly edited throughout the
length of stay to stay current and updated. The charting software will need to be altered to match
the patients checklist and any comments may be added if there are not available areas in the
chart. The educational class will only be done during staff meetings and will not cost too much
of staffs time. There will also be a detailed email sent out to staff regarding the implementation
and what was discussed in the staff meeting.
In the article, A Considerative Checklist to ensure safe daily patient review, Dr. Caldwell
performed a study on the use of checklists to prevent falls in an inpatient study. After
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implementing the use of a checklist in an inpatient setting, it was proven that checklists in
clinical medicine have decreased falls and had a positive effect on patient outcomes (Mohan,
Naina 2013). The fall rate significantly decreased with helpful use and reminder of the checklist.
Dr. Caldwell states, Further to this, having the checklist in front of me allowed me to break the
consultations down under manageable subheadings, thereby forming a framework for the ward.
A Fall Prevention Checklist
Approximately 42.1% of responses of nursing staff towards fall prevention were
inconsistent with a safe patient environment and only 26.9% of the unit recognized the support
for providing efforts to keep patients safe (Black,Alex A. 2011). Along with varying medications,
tubes and wires connected to the patient, and unsupervised patient mobilization, the fall rate in
inpatients hospitals are significantly increased and overwhelming to all involved. Patient-focused
care, preparation, and daily communicational fall prevention reminders are key conclusions that
may lessen the rate of falls drastically in inpatient units. An organized method of tracking
prevention strategies and keeping nurses updated on their patients mobility level requires critical
thinking skills and the implementation off a fall prevention checklist.
An Approach to Prevent Falls
An approach that has been recognized to expand patient fulfilment and decrease risk
factors leading to falls is the familiar nursing duty known as Nursing Rounds. The motivation
behind this method stems from the impact to increase nursing knowledge and skill, while also
catering to patients needs to satisfy their well-being. With the addition of a fall prevention
checklist during nursing rounds, the goals is to verify the patients limitations with a second nurse
to then assist and cater to the patients needs, while also decreasing risk factors that lead to falls.
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Method Evaluation and Perception
For evaluation of this method, questionnaires, group discussions, patient satisfaction
forms, structured interviews and recording forms, will be used to collect data and assess the fall
rate difference in three months time. The following outcomes will then be assessed: the extent to
which the multidisciplinary fall prevention program was performed according to protocol, the
nature of the recommendations and referrals provided to the participants, participants' selfreported compliance and participants' and practitioners' opinions about the program (Bleijlevens,
Michel H.C. 200). Teamwork, compliance, and understanding of this project are three factors
that are needed to make this project successful. Without these components, the project will fail
and patient satisfaction may not improve. Staff involvement takes patience, understanding, and
time. A crucial element in reaching the goal of teamwork is communication and active listening.
A structured questionnaire and semi-structured interview guidelines will be used to obtain
information about nurses knowledge of fall prevention and the Falls; their attitudes towards
evidence-based guidelines; and influencing factors are focal points that will be carried
throughout this project (Breimaier,Helga E. 2015).
The use of reliability and validity are common in quantitative research. These tools are used
for a natural approach to evaluate perspective and truth of a study. "Like reliability and validity
as used in quantitative research are providing springboard to examine what these two terms mean
in the qualitative research paradigm, triangulation as used in quantitative research to test the
reliability and validity can also illuminate some ways to test or maximize the validity and
reliability of a qualitative study"(Golafshani, N., 2003). Therefore, from a qualitative point of
view, reliability and validity have to be redefined in order to reflect the multiple ways of
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establishing truth. This is done so that the study represents truth and meaning which in return
will make a positive difference.
Developed Tools Necessary to Educate Project Participants
Educational meetings, distribution of written materials, local opinion leaders, audit and
feedback, adaptation of nursing record systems and changes in physical structure, facilities and
equipment are applied to educate project participants (Breimaier, Helga E. 2015). Educational
meetings will be held quarterly to inforce and enhance the utilization of the fall prevention
checklist program. These meetings will include written information that highlights the
importance of each bullet point and a short description of each intervention on the checklist will
be reviewed as well as a fall prevention checklist template. Only what applies to each individual
patient will be reviewed to make that portion of the huddle, yet thorough Communication will be
a pivotal factor in this implementation to enforce, guide, and to reiterate the importance of this
implementation.
Variables to be Assessed
The Nursing turnover can be a stressful issue the undoubtedly affects the performance
and job satisfaction of a nurse. The increased rate of nursing turns overs greatly affect nurse to
patient ratios, creating an unsafe, stressful environment (Steven T. Hunt, 2009). This project has
a great influence on patients, tolerant administration, and nursing staff.
It is with hopes the implementation of an organized fall prevention checklist, patient
fulfilment will be increased, and the anxiety and vulnerability of nurses will be decreased during
their shifts. This checklist is designed to create an organized nursing routine that involves quality
care delivered to the patient. If nurses are to comply with the fall prevention checklist during
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rounding, they are attending to their patients needs in a thorough and present way. The presence
of a nurse is usually appreciated by the patient making them feel cared about. With two nurses,
tasks are completed promptly, and the patient may feel like they getting what they deserve
especially from two nurses instead of one. In return, both nurses will be on the same page about
their patients care and it is with great hope that the patient and nurse will be in agreement about
their plan of care for the shift. All of these factors are intended to improve patient safety, increase
nursing skill and knowledge, decrease fall rates, and reduce the nursing turnover rate.
Patient Discharge Surveys
A patient discharge survey is highly likely to be a useful tool to discharge strategies and
increasing knowledge on nursing education practices. The survey can help assist grey areas in
patients knowledge they received during discharge by helping patients understand about their
health. A patient survey can also represent statistical information on patient safety and
satisfaction. Further knowledge work is required to determine when and how it should be
provided. With appropriate training and support, our findings suggest that it is possible for
nurses to write effective patient discharge summaries in a busy health care environment and that
such information may help facilitate early recovery, but this still needs to be demonstrated in
terms of patient outcome (Bench,Suzanne D. 2014). Discharged patients have the opportunity to
take a survey in the hospital during discharge, online, or at home.
Disseminating Significance of Project Results
The process of making the outcomes of a project available to stakeholders and a wider
audience is known as dissemination (Walsh,N. 2010). This term uses a set of organized actions
designed to promote and empower incorporation and application of validated strategies.
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Dissemination of results is important in maintaining the practice and the outcome for appropriate
fall prevention practices in medical-surgical units.
Disseminating Project Results to Key Stakeholders
To evaluate the effectiveness of the use of a fall prevention checklist outcome to
stakeholders, control programs will be disseminated into a facility where the implementation will
take place. There are several reasons why the dissemination of the results of project to key
stakeholders is crucial. It is necessary to inform project development, to receive feedback and to
assure that the practice and the outcome will be maintained after the implementation of the
project. The stake holders for this project are Medical Surgical Nurse management, Nurse
Educators, Nursing Staff, the CEO of the hospital, the Director of Nursing and the Director of
physical therapy and Evidence Based Practice Committee. Key measures will include levels of
usefulness and satisfaction of participation by study participants (Mueller,N.B. 2008). Surveys
and history related to the falls will assist in understanding how and why the fall occurred. A post
fall survey will be reviewed to distinguish the result of the fall and incorporated into the fall
prevention checklists. A consideration of each individual fall will be considered as the
components of the checklist will be arranged.
Disseminating Significance of Project Outcomes to Greater Nursing Community
The results of the project will be presented through emails, staff meetings, and bulletin
boards in the nursing break room and bathrooms. Staff meetings will include workshops, input
on the project, and ideas to brainstorm ways to better the utilization of the project.
Communication and the invitation to participate in a fall prevention checklist conference to
nurses in the community will be highly encouraged to disseminate significance of the project
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outcomes to the greater nursing community. With the arranging of workshops and conferences,
nurses will feel like they are part of the project and will be able to voice their opinion to better
the project and results. The society places on the managements of medical attendants and the
centrality of the departments to the benefit of the general publicity is vital for medical attendants
to incorporate their insight, capacities, and abilities with demeanours of restrictive requirements
an essential key to performing activities with competencies (Teles, 2007)
Conclusion
The process of dissemination is vital because it spreads useful information that can be
incorporated to better a project by the decision makers involved. When it reaches decision
makers the format can be adopted make the project more efficient in the delivery of healthcare.
The hospital can be an unfamiliar frightening environment for patients. There are constant alarms
sounding and beeps occurring from unknown equipment that may terrify someone who is foreign
to this type of setting. When a patient is admitted to a hospital, there are policies and procedures
in place that are aimed to keep a patient safe and free from injury. Without any introduction or
education to policies and guidelines, patients would have no idea to use their call light for help
when getting out of bed. The unfamiliar tugs and pulls of drains and tubes when a patient is
actively being mobile might seem like a minor detail, but it is a huge factor that leads to the
increased rate of patient falls in an inpatient unit. For this reason, interventions are put into place
to reduce the fall rate and to keep patients safe. Unfortunately, with the variety of risk factors,
such as an unfamiliar environment to the patient and the nurse lacking awareness, patients are
experiencing falls that could have probably been prevented. It is unique models of adjusting to
performed in inpatient settings, typical components incorporate logical one to two hourly patient
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adjusting, concerning agony administration, toileting, repositioning, and natural calculation
(Black,Alex A. 2011).
With the use of a fall prevention checklist during bedside report, a positive impression on
patient care can be left, leaving the patient and nurse with peace of mind. The benefits of this
checklist gives vital information to nurse of the care required to adequately provide to the
patient. With a decrease of fall rates, there is a decrease of nursing work and hostility on the
health care environment. This respectable program can work if used adequately with the
assistance of teamwork and encouragement.
It has been proven that hospital settings are unfamiliar environments to patients
increasing the rate of falls due to unforeseen circumstances. Along with varying medications,
tubes and wires connected to the patient, and unsupervised patient mobilization, the fall rate in
patients is increased and overwhelming to all involved. The implementation of a fall prevention
checklist during nursing rounds is geared towards a decrease in inpatient falls.
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Review of Literature
Article 1
Black, A. A., Brauer, S. G., Bell, R. A. R., Economidis, A. J., & Haines, T. P. (2011). Insights
into the climate of safety towards the prevention of falls among hospital staff. Journal of
Clinical Nursing, 20(19), 2924-2930. doi:10.1111/j.1365-2702.2010.03535.x
Problem identified - This article aims to explore the safety environment towards fall prevention
encompassed by hospital staff.
Statistical data Approximately 42.1% of responses of nursing staff towards fall prevention were
inconsistent with a safe patient environment and only 26.9% of the unit recognized the support
for providing efforts to keep patients safe.
Study The focus was on two hospitals and specified five subacute and acute units. The safety
environment was measured by taking a Safety Climate in Healthcare Organizations survey.
The calculations of problematic responses were observed based off the inconsistent and frequent
responses of an inadequate patient safe environment.
Result - The study proposes that the higher percentage of responses that were problematics
results in weaker patient safety environment.
Conclusion The implementation of a safety prevention checklist will help to keep unit based
staff members aware of safety precautions to keep patients in a safer environment.
Article 2
Breimaier, H. E., Halfens, R. J. G., & Lohrmann, C. (2015). Effectiveness of multifaceted and
tailored strategies to implement a fall-prevention guideline into acute care nursing practice:
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A before-and-after, mixed-method study using a participatory action research
approach. BMC Nursing, 14(1), 1-12. doi:10.1186/s12912-015-0064-z
Focus- The aim in this study was to assess the effectiveness and time invested required to
implementing a strategy for a fall-prevention guideline in an acute care hospital. The fall
prevention guideline is evidence based and used a mixed-method design.
Statistical data Data was collected through semi-structured reviews, questionnaires, and group
discussions. Qualitative data were content-analyzed using a template based on the Consolidated
Framework for Implementation Research (CFIR), which also served as a theoretical framework
for the study (Breimaier, H. E., Halfens, R. J. G., & Lohrmann, C., 2015). For independent
groups, appropriate tests were used to gather the quantitative data.
Result Participants showed an increase interest in fall prevention and positive attitudes
improved towards fall preventions guidelines towards the end of the project
Conclusion When staff is properly educated on a fall prevention guideline, they are more likely
to participate in patient fall prevention and safety.
Article 3
Choi, Y., Lawler, E., Boenecke, C. A., Ponatoski, E. R., & Zimring, C. M. (2011). Developing a
multi-systemic fall prevention model, incorporating the physical environment, the care
process and technology: A systematic review. Journal of Advanced Nursing, 67(12), 25012524. doi:10.1111/j.1365-2648.2011.05672.x
Problem identified- This article reports a review that assessed the effectiveness and
characteristics of fall prevention interventions implemented in hospitals. The observation of falls
occurring through environmental related risk factors suggests that fall prevention approaches are
needed to decrease complex interactions between unsafe patient related environments.
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Statistical data A narrative summary was used along with a quantitative systematic review to
report findings.
Result - It was observed that the evidence of patient falls in relation to environmental risk factors
results in patient related falls.
Conclusion - This article accurately supports the proposed implementation of creating a fall
prevention checklist to decrease patient related injuries which in return will benefit the patients,
culture, and improve technology. In accomplishing this, other various risk factors that increase
fall rates can be identified.
Article 4
Elnitsky, C. A., Lind, J. D., Rugs, D., & Powell-Cope, G. (2014). Implications for patient safety
in the use of safe patient handling equipment: A national survey Retrieved
from https://lopes.idm.oclc.org/login?
url=http://search.ebscohost.com.lopes.idm.oclc.org/login.aspx?
direct=true&db=edswss&AN=000347023500010&site=eds-live&scope=site
Focus- Due to the high rate of patient injuries related to falls, this articles aims to explore safe
patient handling equipment and preventative approaches to keep patients safe while using
equipment.
Statistical data Data was gathered from 51 Veteran Affairs medical centers by surveying safe
patient handling managers. The survey focuses on skin and fall related injuries due to adverse
effects cause from safe patient handling equipment.
Result Due to the incorrect use of patient handling equipment, patients obtained injuries such
as sprains and abrasions. This calls for new and effective ways to use equipment and find out the
main cause of these injuries.
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Conclusion The use and awareness of safe patient handling equipment in this article is geared
towards the risks for patients safe handling equipment may cause. Overall, education should be
provided on proper use of equipment and proper equipment for each individual patient.
Article 5
Feng, X.Q. Acord, L. Cheng, Y.J. Zeng, J.H. Song, J.P., & Feng, X. Q. A. (2011). The
relationship between management safety commitment
and patient safety culture. International Nursing Review, 58(2), 249. Retrieved from
RefinerQuery database.
Focus- The focus of this article is to explore the safety culture and commitment within
management in a Chinese hospital.
Statistical data A cross sectional-survey was used with a correlational research methodology.
All together there were 248 nurses used to identify the interconnection between safety
management and commitment to keeping patients safe using a self-administered questionnaires.
Result Evidence reveals that the association of management with patient safety culture is
imperative in decreasing patient falls.
Conclusion - The goal of this article is to build a positive safety culture environment with the
guidance and compliance of management to ensure the safety of patients.
Article 6
Haines, Terry P., Hill, Anne-Marie3 Hill, Keith D.Brauer, Sandra G. Hoffmann, Tammy,
Etherton-Beer, Christopher McPhail, Steven M. (2013). Cost effectiveness of patient
education for the prevention of falls in hospital: Economic evaluation from a randomized
controlled trial.11, 1-12.
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Problem identified- The article describes the unfortunate frequency of patient falls related to
adverse event in a hospital setting.
Focus - Finding cost effective ways to prevent falls from occurring in hospital settings.
Statistical data Incremental cost-effectiveness analysis was undertaken from the health service
provider perspective, over the period of hospitalization (time horizon) using the Australian
Dollar (A$) at 2008 values (Haines, Terry P., Hill, 2013).
Study If the proportion of cognitively intact patients falling on a ward under usual care
conditions is 4% or greater, then provision of the complete program in addition to usual care will
likely both prevent falls and reduce costs for a health service just as my proposed
implementation is aimed to do (Haines, Terry P., Hill, 2013).
Conclusion This study was performed to encourage and assist nursing staff members of
methods and implementations should be provide to prevent falls from occurring.
Article 7
Ireland, S Kirkpatrick, H Boblin, S Robertson, K (2013). "The Real World Journey of
Implementing Fall Prevention Best Practices in Three Acute Care Hospitals: A Case Study".
Worldviews on evidence-based nursing (1545-102X), 95.
Problem identified- This article describes the nature of the patient fall rate issue as it is ranked
the second as an area of patient safety concern in Canada.
Study Case study methodology is used to collect data on 95 point of care nurses in three
hospitals. The hospitals participated in focuses groups, interviews and provided statistical
documents that included their implementation of fall prevention.
Result Findings and implications four recommendations with potential to guide others in fall
prevention were identified: (1) the need to listen to and recognize the expertise and clinical
realities of staff, (2) the importance of keeping the implementation process simple, (3) the need
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to recognize that what seems simple becomes complex when meeting individual patient needs,
and (4) the need to view the process as one of continuous quality improvement (Ireland, S
Kirkpatrick, H Boblin, S Robertson, K, 2013).
Conclusion - This article accurately supports the proposed implementation of using a fall
prevention check list because this articles goal was aimed to provide insight into best practices in
preventing fall prevention. This checklist will decrease the rate of falls and also provide insight
to best practices in fall prevention.
Article 8
J Meyer, R., & Schwendimann, R. (2006). Falls and consequent injuries in hospitalized patients:
Effects of an interdisciplinary falls prevention program. BMC Health Services Research, 29
Suppl 2(7228), 8. Retrieved from RefinerQuery database.
Problem identified- This article relates to the rate of fall prevention programs created to decrease
falls has been unsuccessful and needs further adjustment in a 300-bed hospital.
Statistical data - In this article, 34,972 patients who were in the hospital were observed. The
(mean age: 67.3, SD +/- 19.3 years; female 53.6%, mean length of stay: 11.9 +/- 13.2 days,
mean nursing care time per day: 3.5 +/- 1.4 hours) were observed during the study period (J
Meyer, R., & Schwendimann, R., 2006).
Study The study included adult patients who were hospitalized in different units of the hospital.
Results As the implementation of the fall prevention program was initiated, neither the falls or
frequencies decreases significantly.
Conclusion Due to the failure of this fall prevention program, further research needs to be
conducted to evaluate compliance with the program with both nurses and patients. The program
might also need further adjustments to be more successful.
Article 9
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Kirwan, M., Matthews, A., & Scott, P. A. (2013). The impact of the work environment of nurses
on patient safety outcomes: A multi-level modelling approach. International Journal of
Nursing Studies, 50(2), 253-263. doi:10.1016/j.ijnurstu.2012.08.020
Problem identified- The relationship aims to explore the relationship between the environment in
the facility and nurse practice in relation to patient safety and fall outcomes.
Study There are 108 units included in the 30 hospitals studied to analyze patient safety in this
quantitative study. Nurse who directly work with patients were invites from any and all units.
Approximately 1397 nurses were used in the analysis and included in data.
Results Findings were an indication that a positive atmosphere promotes patient safety
outcomes. With educational classes and practice sessions to increase a nurse skill level and
knowledge were found to greatly impact patient safety. These results are used to enhance patient
prevention programs and enables nursing staff to adequately carry out safe measures to care for
their patients.
Conclusion - This article accurately supports the importance of nursing education and a positive
work environment that greatly influences nurses for the better.
Article 10
Lara-Medrano, R., Alczar-Quiones, C., Galarza-Delgado, D., & Baena-Trejo, L. (2014).
Impact of a fall prevention program in the internal medicine wards of a tertiary care
university hospital. Medicina Universitaria, 16(65), 156-160. Retrieved
from https://lopes.idm.oclc.org/login?
direct=true&db=a9h&AN=109202208&site=eds-live&scope=site
28

Problem identified- This article is aimed to determine whether a falls prevention program
reduces the incidence of falls within a hospital.
Statistical data Quantitative and qualitative variables were used in the descriptive analysis to be
expressed as proportions. To compare the rate of pre- and post-program implementation falls,
was used, with a = 0.05 determining a significant statistical value (Lara-Medrano, R., AlczarQuiones, C., Galarza-Delgado, D., & Baena-Trejo, L., 2014).
Result - The fall rate has decreases from 1.9 to 0.67 since the implementation of the fall
prevention program, represents a significant decrease of 70% from 1997-2008.
Conclusion The fall program implementation is a resourceful tool that reduces the rate of falls
and possible complications associated falls if the program used correctly.
Article 11
McMahon, S., Talley, K. M., & Wyman, J. F. (2011). Older people's perspectives on fall risk and
fall prevention programs: A literature review. International Journal of Older People
Nursing, 6(4), 289. Retrieved from https://lopes.idm.oclc.org/login?
direct=true&db=edb&AN=67197948&site=eds-live&scope=site
Focus- This article evaluates the understanding of the views of fall risks and fall preventions
strategies according to the elderly population in order to broaden the design of a fall prevention
programs for nurses based on their scope of practice.
Statistical data- There were 19 qualitative and quantitative studies that went under review.
Included in this review was the examination of the perspectives of the elderly population.
Result Despite the use of fall prevention programs, there is still a rise in fall-related injuries
that occur within this population.
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Conclusion The proposed implementation needs practice, nursing education, patient education,
adjustment, and strategies to prevent falls based on the needs of the individual.
Article 12
Mohan, N. C. (2013). A considerative checklist to ensure safe daily patient review. The Clinical
Teacher, Retrieved from RefinerQuery database.
Focus- This article focuses on a physician, Dr. Gordon Caldwell, and his implementation design
to incorporate a checklist to perform a comprehensive patient review that ensures policies and
hospital protocols are adhered to in order to prevent falls and keep patients safe.
Result - Further qualitative and quantitative research is required to investigate whether or not
nurses and patients are in compliance with this checklist.
Conclusion - There needs to be further research to investigate whether the use of the checklists
improves nursing knowledge, skill and patient compliance. It also needs to be noted if the use of
the checklist enhances staff performance.
Article 13
Sand-Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes
of bedside nursing report implementation. Journal of Clinical Nursing, 23(19), 2854-2863.
doi:10.1111/jocn.12575
Focus- The focus of this article was to increase quantitative outcomes of performing bedside
report that decreased the risks of patient error and falls.
Statistical data - The design used A Quasi-experimental pre- and post-implementation design was
used to analyze the use of bedside report in seven different medical-surgical units.
30

Study During bedside reports, patients needs were addresses, patient fall risks were assessed,
and education was provided and/or reiterated.
Result The outcomes from using an efficient bed side report method included satisfaction to
both patients and nurses; decreased patient falls and medication errors, and improved the overall
atmosphere of the unit. There were major improvements post-implementation and safety areas
were greatly improved. There was an issue of nurses reporting that this type of implementation
was time consuming and took away from other important tasks, although there was no record in
nurse overtime. There was a huge decrease in patient falls during shift change if the bedside
report was properly implemented.
Conclusion A nursing bedside report is essential for every facility to incorporate in their daily
nursing routine. If the use of bedside report is practiced properly, nursing bedside report can
result in improved patient and nursing satisfaction and patient safety outcomes. Nursing mangers
should continue to involve staff nurses in the process of the implementation and monitor the
consistency of this initiative.
Article 14
Schwendimann, Rene, Buhler, Hugo, De Geest, Sabina, Milisen, Koen. (2006). Falls and
consequent injuries in hospitalized patients: Effects of an
interdisciplinary falls preventionprogram.6, 69.
Problem identified- The problem identified is focused on how patient falls can lead to other
negative outcomes. This article uses a survey design to explore the fall rates in patients after the
implementation of a fall prevention program.
Study Patients were observed in a 300-bed urban public hospital using age, sex, and length of
stay. Out of the 3,842 patients that fell, 2,512 (7.2%) were affected from the falls and a while
2,552 were without injuries, 29.7% acquired minor injuries and 3.9% resulted in major injuries.
In the hospitals population, there were about 8.9 falls about every 1,000 days.
31

Result - The implementation of this fall prevention program did not show improvement nor did
injuries or falls decrease.
Conclusion - Further research is needed.
Article 15
The contribution of staff call light response time to fall and injurious fall rates: An
exploratory study in four US hospitals using archived hospital data.(2012). BMC Health
Services Research, 12(1), 84-97. doi:10.1186/1472-6963-12-84
Focus- Examining the response time to answering call lights in relation to predicting and
preventing fall rates during that time.
Study Four hospitals were used to retrieve data about response time to call light and the falls
the happen during that response time.
Result The quicker the call light response the less chance a patient has at falling, which results
in decreased fall rates.
Conclusion More research should be conducted and further education needs to be provided to
patient to not getting out of bed until someone is there to help them. Also the implementation of
bed alarms on fall risk patients should be noted.
32
Resources
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Black, A. A., Brauer, S. G., Bell, R. A. R., Economidis, A. J., & Haines, T. P. (2011). Insights into
the climate of safety towards the prevention of falls among hospital staff. Journal of
Clinical Nursing, 20(19), 2924-2930. doi:10.1111/j.1365-2702.2010.03535.x
Bleijlevens, M. H. C., Hendriks, M. R. C., van Haastregt, Jolanda C. M., van Rossum, E.,
Kempen, G. I. J. M., Diederiks, J. P. M., et al. (2008). Process factors explaining the
ineffectiveness of a multidisciplinary fall prevention programme: A process evaluation.
BMC Public Health, 8, 332-342. Retrieved from https://lopes.idm.oclc.org/login?
direct=true&db=a9h&AN=51487031&site=eds-live&scope=site
Breimaier, H. E., Halfens, R. J., & Lohrmann, C. (2015). Effectiveness of multifaceted and
tailored strategies to implement a fall-prevention guideline into acute care nursing practice:
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A before-and-after, mixed-method study using a participatory action research approach.
BMC Nursing, 14, 18-18. doi:10.1186/s12912-015-0064-z
Feng, X.Q. Acord, L. Cheng, Y.J. Zeng, J.H. Song, J.P., & Feng, X. Q. A. (2011). The
relationship between management safety commitment
and patient safety culture. International Nursing Review, 58(2), 249. Retrieved from
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improvement program to prevent falls among community-dwelling older adults in an
integrated healthcare system Retrieved from https://lopes.idm.oclc.org/login?
direct=true&db=edswss&AN=000271921700001&site=eds-live&scope=site
Graham, B. (2012, September to October). Examining evidence-based interventions to prevent
inpatient falls. MEDSURG Nursing, 21(5), 267-270.
Haines, T. P., Hill, A., Hill, K. D., Brauer, S. G., Hoffmann, T., Etherton-Beer, C., et al. (2013).
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direct=true&db=edb&AN=67197948&site=eds-live&scope=site
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NRS-441V: Capstone Project

Running head: EFFECTIVENESS OF A FALL PREVENTION CHECKLIST